Healthcare Provider Details

I. General information

NPI: 1740107648
Provider Name (Legal Business Name): DEMETREE BENTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8929 J M KEYNES DR # 330E
CHARLOTTE NC
28262-8406
US

IV. Provider business mailing address

8929 J M KEYNES DR # 330E
CHARLOTTE NC
28262-8406
US

V. Phone/Fax

Practice location:
  • Phone: 704-900-7488
  • Fax: 855-583-7047
Mailing address:
  • Phone: 704-900-7488
  • Fax: 855-583-7047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: